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Counseling Request

Our Biblical Counseling Ministry is led by Pastor Pam Ingold, Congregational Care Pastor, and a team of lay counselors. Please fill out this form and Pastor Pam will connect with you to get you started.

Your name *

Last name

Email address *

Confirm email address *

I'm requesting: *

Gender *

Birthday *

Age *

Address *

Country

Country

Street Address

Apt/unit/box (optional)

City

State

Postal code

Phone Number *

Phone type

Spouse's Name (if requesting couple's counseling)

Spouse's Email

Spouse's Phone Number

Spouse's Birthday

Do you attend The Church at RB? *

Please explain your reason for wanting to see a counselor *

Best day(s) to meet (in general) *

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Best time of day to meet (in general) *

Morning

Afternoon

Evening

What is your preferred way to receive counseling? *

Zoom or in person are both fine

In person at The Church at RB

Through zoom

In a few words, describe your walk with the Lord *

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The Church at RB
info@thechurchrb.org
(858) 592-2434

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